Means and method for orthoptic exercises



Aug. 13, 1940- J. F. NEUMUELLER MEANS AND METHOD FOR ORTHOPTIC EXERCISESFiled NOV. 25, 1935 4 Sheets-Sheek l In' L' '-'JU NvENToR L/usFNEuMuELLE/ Aug. 13, 1940. J. F. NEUMUELLER 2,211,072

MEANS AND METHOD FOR ORTHOPTIC EXERCISES Filed Nov. 23, 1935 4Sheets-Sheet 3 INVENTOR Jaz/Jus /VEuMuE/.me

'rToRNEY Aug. 13, '1940. J. F. NEUMUELLER 2,211,072

MEANS AND METHOD FOR ORTHOPTIC EXERCISES Filed Nov. 23, 1935 4Sheets-Sheet 4 O N E O N E ON NE INVENTOR deL/us F/VEUMUELLEE PatentedAug. 13, 1940 MEANS AND METHOD 'Foa oRTHoPCrIG EXERCISES v d v Julius F.Neumueller, Quinebaug, Conn., assi-guury to American Optical Company,Southbridge, Mass.,' a voluntary association of MassachusettsApplication November 23, 1935, Serial No. 51,245

This invention relates to improvements inophthalmic instruments andhasjparticular reference to means and method for `training andexercising the eyes and especially the single binocular functions of thetwo eyes. l

One of the principal objects of the invention is to provide improvedmeans and method for-exercising the functions of the eyes.

Another object of the invention is to provideav novel and improveddevice for training the co"- ordination of the vextrinsic and intrinsicmuscles of the eyes for greater efficiency in binocular single vision.

Another object is to provide animproved device for exercising anddeveloping the accommodative functions of the eyes. f

Another object is to develop greater reserve of fusional vergence,ductions, etc.

,Another object is tolprovide a novel, simple and improved device forexercising the eyes to bring about increased amplitude of accommodation.

Another object is to provide an improved appa*- ratus and methodforbringing about improved coordination between accommodation and con'-vergence for greater efficiency in the performance of the eyes inbinocular single vision.

Another object is to train the fusional faculties and stimulate visionina sob-called amblyopic eye, or eye that has lost part of itsvisualacuity from nonuse. l

A further object is to provide an improved ap'- paratus and method oftraining to vbreak up the habit of suspension of vision "in one eyeAor'the other in cases of amblyopia exanopsia, or suspen- Opsia" Anotherobject is to provide an improved means and method for exercising theeyes to train them against suspension of vision.

A further object is to provide'an improved, simple, inexpensive andeicient device capable of use with slight instruction, adapted forexercising the ocular muscles in` accordance with the` main purpose ofmy invention. y*

A still further object-isvto provide a novel apparatus having aplurality of fmeans adapted to be moved before a persons eyes,fwhe'r'eby said means are viewed monocularlywhile 'attaining binocular singlevision, said means being moved in circular or other paths' whilebeing-,maintained against rotative movement relative to the line ofsight of said persons eyes.

Another object is to providev a simple device for exercising the eyeswhich is readily attachable to-commercial instruments havingbatteries ofwith ycommercial ophthalmic instruments `which the motion of thefixation object can be linterchangeablerefractive devices, whereby thelatter may be utilized to assist in the exercise.

Another object is to provide an improved eye exercising device in whichperception of stereopsis f can be increased by causing two fusible'objects to be moved ina circular or .other path and causing a person toView said fusible objects through `prisms which may be varied to vvarythe exercisev of the eyes. l 'Another Objectis tovprovide a device foruse readily variediatwill. v Other objects and advantages of the:inventionA will become apparent from the' following descrip# tion `takeninconnection with the: accompanying drawings, .and itnwill be apparentrthat many changes ymay be made-in the details ofconstruction,'arrangement of parts, steps of the method shownanddescribedwithout departing from the spirit of the'invention asexpressed in the accomvpanying claims. '-Lthereiore, do notwish to belimited to the exacty details and steps of the method shownanddescribed, as the preferred forms only have been shown in the wayof'illus'- tration. Y

Referring to the drawings:` v

Fig. I is a perspective viewof an assembly showing an embodiment of theinvention adapted to be attached to a standard commercial ophthalmic 1instrument; Y f

Fig. II is a rearelevationalvview of my inven- .tion and showslthe`various positions'the target holder passes through when'it is moved toexercise the eyes;` if

Fig. III is 4 a 1 partial sectional plan view of Fig. 11;. f l

Fig. IV isa partial side elevational sectional View along line IV`- IVof Fig. III and looking in the directionof the arrows; 'v

Fig. V is a rear elevational View of a modication 'of the mechanismshown in Figs. II, IIIand IV for maintaining ,the target and targetholder against rotation relative to the line of sight while the targetis moved in circularlpaths;

Fig. VI isla partial side `elevational sectional view taken on lineVI-VI of Fig. V;

Fig. VII shows a target adapted to give vergence exercises withoutguarding against suspenopsia;

Fig. X shows a target having non-fusible symbols, such as a red dot anda green dot; and

Fig. XI is a modified form of the target holder for holding a targetcomprised of separable sections.

The purpose of my invention is to provide a simple and eicient devicewith the use of which a persons eyes may be readily subjected to theproper exercises to maintain them in condition to perform their properfunctions and thus avoid defects in vision due to one or more of theocular muscles failing to properly or fully coordinate with the othermuscles and, also, whereby the ocular muscles may be strengthened andrestored to normal conditions and properly perform their functions.

One of the prime causes of ocular discomfort and inefficient vision isthe failure of the two eyes to work in unison and produce similar brainstimulations of sight and perception without stress on the muscles ofthe eyes which control the fusion function. The two eyes may each havenormal visual acuity, but if single binocular vision is absent or poor,ineicient Vision results and discomfort is experienced.

The single binocular vision function is very closely related to themuscular balance of the eye muscles or innervation balances of the same.It is obvious that if the two eyes have the same visual acuity,efficient and comfortable single binocular vision will depend upon theability of the person to orient and accommodate both eyes on the samepoint so that `they may receive the same stimulations of sight.

The ability of a person to have and maintain depth perception orstereopsis `is very closely related to the ability to fuse together inthe brain centers two slightly different images received by each eye. Toobtain comfortable and efcient vision an individual must have goodstereopsis, good quality and quantity of vergence and absence ofsuspenopsia. This invention is directed to an improved apparatus andmethod for exercising the eyes to obtain eficient and comfortable singlebinocular vision.

Referring to the drawings, in which similar reference characters denotecorresponding parts throughout, an embodiment of the invention is shownas an attachment adapted to be used preferably, in conjunction withstandard `come mercial ophthalmic instruments. 'IheV attachmentcooperates with parts of the commercial instruments to give the desiredexercises. Broadly, the essential combination of elements necessary toproduce all of the desired results comprises a lens holding frame II forholding suitable lenses, a target holder I2 carrying a target I andmeans for moving the target relative to the person in a desired mannerwhile the person is Viewing the target through the lenses.

By changing the amplitude of movement of the target relative to thepersons eyes, by changing the lenses through which the person views thetarget and by changing the spacing between the parts of the targetviewed monocul-arly by each eye, very beneficial exercises can beobtained by causing the person to try to follow the movement of thetarget and maintain single binocular vision or simultaneous binocularvision. Y

If desired, means may be provided for illuminating the target eitherintermittently or continuously and the illumination of the parts of thetarget to be viewed by the individual 'eyes may be individually vvariedto provide desired stimulation for either eye. Such illuminating meansare shown in the form of lamps I3 and I4 which may be individuallycontrolled by a control mechanism I 6 which controls the current andvoltage from any suitable source, not shown.

'Ihe lens holding means II is of the usual prior art type adapted to beattached to any suitable floor stand by means of the swiveling connectorI0.

A sliding frame I'I supports a pair of rods I8 upon which are mountedrotary prism cells I9, and at a distance from these the spherical lenscells 2|.

The rotary prism cells I9 each contain a pair of rotary prisms 23 whichcan be rotated in either direction for different powers by means ofknurled handles 24. y

Suitably secured to the lens holding means II in any convenient manneris a supporting arm 26, which carries the' target holder I2. The rodsI8, carrying the lens cells can be moved with the sliding frame I'I toadjust the lenses to the patients pupillary 'distance and an adjustableheadrest 21 will assist in maintaining the patients head in correctposition.

The target holder I2 comprises a supporting frame 28, see Figs. I andII, in which is journalled a manually operable mechanism 29 adapted toactuate a target holding frame 3i carrying spring clips or fingers 32 atthe outer ends of the latter frame, see Fig. I. The actuating mechanismcomprises a hand crank 33, see Fig. III and IV, a stub shaft 3Djournalled in an extension34 of the supporting arm 26, which carries theframe 28, and is connected with an adjustable crank 36 for varying themovement of the frame 3| when the crank 33 is operated. The crank 38comprises a screw member 31 journalled at each end ina Urshaped member38 se cured to stubfshaft and is threadedly engaged by a block 39pivotally connected to guiding block 4I. 'I'he frame 3| is carried bythe guiding block 4 I, which is adapted to slide within a slot 42 in aplate 43. The plate 43 has journalled thereon V- grooved rollers 44, seeFigs. Il, III, and IV, which engage complemental inner surfaces ofupright members 46 of the frame 28. The length of stroke of the crank 36can be varied by operating the knob von the screw 3l to vary the disytance of the block 39 from the center of rotation of the crank 36.. Itwill be readily apparent that when the crank is rotated the frame 3lwill traverse a circular path while being maintained in a constantangular position by means of the guiding plate 43 and the guiding block4I.

If desired, the arm 26 may be provided with a suitable connection to thelens holding support II, in order to move the target in any desired pathbefore the eyes. To this end a pivot 60 is provided whereby the targetholder 3l may be moved up and down, while the pivot EI allows movementof the target holder 3l back and forth in the horizontal plane. Thepivots BU `and Si may be selectively held against operation by means ofbolt and nut assemblies 62 and 63, respectively, extending through ahole in one member of each respective joint and an arcuate slot in theother and adapted to clamp the respective members ofthe joints in tightfrictional engagement. Y .f Y

It will be readily seen that. if the pvot 6I is clamped againstoperation and the pivot 60 is free to operate the, target holder 3Icould be moved upand down by means of a suitable knob 3| could be movedfrom side to side. Byallowingi both pvots'to'operate freely, the ltargetholder 3| could be moved lin any desired path. By simultaneouslyoperatingv the crank 33 and moving the target holder 3| about the pivots60 and 6| a great variety of compound motions could be impartedto thetarget I5. y

A modification of the `target holding mechanism is shown in Figs. .V andVI. Ahand crank 46 is secured to a stub shaft 41 rotatably mounted inthe upper end of the supporting arm 2B. A crank arm 48,'secured` to theshaft 41 carries an idler gear 49, suitably 'journalled-to the arm andadapted to mesh withY a gear| fixed to the support 26 concentric withthe shaft 41 and a gear 52 fixed to a stub shaft 53 journalled in theouter end of the arm 48 and carrying the target holding frame 3|. Therelative sizes of the pinions or gears 49, 5|, and 52 are such that whenthe arm 48 is rotated. the frame 3| will maintain a constant angular.relation while' describing a circular path. If desired, it will bereadily apparent that the construction `may .be readily varied in orderto vary the stroke of the movement of the frame 3|.

The target |5.carried on the frame 3l may comprise suitable cards orother indicia having symbols or parts of symbolsto be viewed monocularlyby each eye 'to actas lbinocular fixation means. i The various formswhich these viewingl means may take. will bei more fully discussedhereafter in connection with the operation of the device. A septum 54 ispreferably carried by the lens holding support I I to prevent' eithereye from seeing bo-th of. the spaced symbols.

In order to illuminate the cards with the lamps i3 and I4, the controlmechanism l5, which may be of any usual prior art type, is connectedfbetween the lamps andany suitable source of elec-4 trical' energy. Aplug 20 can be attached to any convenient lamp socketand for thepurposesof this description shouldbe operated on analternating current source of.suitable voltage.rv The control mechanism I6 may comprise ay suitabletransformer for reducing the Voltage of the source tothe lamps toaconvenient and safe potential. A switch 55 may be interposed in theprimary of the transformer to shut off the supply to both lamps. posedin each of the circuits from the secondary of the transformer to theindividual lamps I3 and I4 to vary the brilliancy of each lamp andlikewise suitable switches 58 in each circuit may be utilized to shutoff completely the illumination of either lampv while the other isilluminated. Although the embodiment of the invention shows theswitching means to be hand operated, it is within the scope of thepresent invention to operate same by automatic means.

In the operation of the device and to carry out the objects of theinvention, suitable viewing means such as cards, one end havingA theletter F and the other the letter L are placed in 'the target holderunder the clips 32. Various cards with different spacings between theletters or separate cards, which may be movable relative to each otherto vary the distance therebetween or to vary the prism effect, may loeprovided. The lamps are preferably provided with suitable shades orreflectors to prevent the light from either lamp from lighting both ofthe letters or symbols. The variation of illumination for the` differentparts of the chart or target introduces A rheostat 51 may beinterdifference 'in visualstimuli in cases of amblyopia.

v'Ihe patient-iis seated before the instrument withhis 'head against theheadrest' 21, and the lateral vdistance between the lens cells is variedto/t the individual patient by sliding the frame '|1...Suitable4accommodation lenses 2| of powers determined by the amount ofaccommodation desired during exercising;.areplaced in the cells beforethe eyes.l .The cards are held in the card holder. at a v.predetermined.distance from "the lenslcells andth'en the amount of accommodationcani-be obtained` by -using a lens vwhose focal length, subtracted fromdioptric distance between thecards and lenses gives theaccommodationdesired. For example, the cards are usually placed tencentimeters from the lens cells vand v if accommodation of plus onediopter is desired, aflens having' a focal power of plus nine diopterswould be placed infront of the eye. If plus two accommodation isdesired, a lens having a focal power'of v'plus 8 would be required,etc.. The amount of prism power in front of each eye is then. adjusteduntil the patient is -able to main- Y This base.:out orxbase up or downas desired. It will be apparent that the vergence power of a 'patientseyes may be increased by vusing base in or` base out prisms. The controlof the vergence exercises can. be effected either by means of rotary. or:loose prisms from one or both eyes or also bymechanical adjustment ofthe distancer between the cards horizontally or vertically.

In` cases of persons having an exophoriccondition I give prisms base outexercises, thus build- -ing4 upabduction power which acts as a reserveagainst the exophoria; and conversely for esophoria` base `in'v prism.exercises are given* to build upa reserve of abduction power.

By the use of stereoscopic cards placed in the holder and rotated thestereopsis faculties are exercised and the fusional areas are increased.The amount of prism power can be varied during such exercises to alsoincrease the vergence power by increasing `anddecreasing the convergenceand divergence.

The fixation means used on the target I5 may take a variety of forms inorder to obtain the most benecial results in particular instances. Forinstance, Where it is desired to obtain vergence exercises only Withoutcontrol against suspenopsia, the symbols `of. the target to be viewed byeach eye are identical, for example, ONE on either end of the target, asshown in Fig. VII. The eyes follow the fused symbols and thus when thetarget is moved and prism power applied the vergence muscles only areexercised.

The targets I5 shown in Figs. VIII and IX are preferably used forobtaining vergence exercises Vas well as for training againstsuspension.

In F'ig.` VIII the target comprises a plurality of symbols havingidentical or similar parts, such as the letters N which fuse together,and other parts such as the letters O and E which are associated withthe identical parts 'to form a completed fixation means when theNs arefused together by the person. Fig. IX shows a target having similar butdisparate parts, such as stereoscopic pictures having similar parts ofdifferent sizes and/or having diierent relative positions. Thedisparation of the retinal images stimulates the stereopsis. l

The target l5 shownr in Fig. X, having nonfusible symbols, such as a reddot for one eye and a green dot for the other, may be used for eyeexercises to train against suspension or amblyopia.

As shown in Fig. XI, symbols of the targets may be movable laterally ofeach other in order to vary the prism effect produced by the spacedsymbols. In such an arrangement the target holder frame 3l may have anupturned outer rim 53a forming a channel at the lower edge of said framewith leaf springs 54a secured to said rim as by Welding or soldering at55 and adapted to press against sections 56 of the target which carrythe separate fixation symbols, to hold them against the back of theframe 3l. An integral rim 5l turned down from the upper edge of theframe forms a guide channel for the upper edge of the target sections.By moving the sections 56 of the target toward and away from each other,the prism effect may be varied. The outer edge of the lower rim 53 maybe provided with a double scale 58 reading from the center toward eachend. The scale may be graduated in millimeters and any suitable mark maybe placed on the sections 56, or the edges of the sections may serve toindicate the distance between the sym bols on the sections 56. II"desired, these scales may be calibrated in degrees of prism diopters toindicate the amount of prism effect when the target is at apredetermined distance from the lenses.

It is to be understood the split stereogram type of target may be usedfor any of the targets particularly adapted for the different exercisesabove described.

Although an embodiment of the invention is shown in the form of anattachment for a standard commercial ophthalmic instrument, it is to beclearly understood that the invention is not limited thereto and anembodiment may comprise a completeand separate instrument in itselfembodying the features shown and described.

In the specication and claims the term lenses is used in a generic senseto include all kinds of refractive devices, such as prisms, lenses orprisms combined with all forms of lenses.

From the foregoing description it will be apparent that I have provideda novel means and method for exercising eyes to stimulate binocularfunctions. The apparatus is readily attachable to standard instrumentswhereby the lenses of such standard instruments may` be used.

Having described my invention, I claim:

l. An attachment for an ophthalmic instrument, comprising a supportadapted to be attached to said instrument, a frame carried by saidsupport having side members, a guide plate mounted on said frame forreciprocatory movement parallel to said side members, a guide blockmounted on said plate for movement relative toI said plate at rightangles to the movement of said plate, target carrying means fixed tosaid guide block, and means for actuating said block in a circular pathlying in the plane of said target carrying means.

2. An attachment for an ophthalmic instrument for use with a personseyes comprising a support having means for attachment With said 'linstrument, said support constituting in part a frame, a member mountedon said frame for movement in a direction longitudinally thereof, saidmember having a slideway extending in a direction vsubstantially normaltothe first direction of movement, a slide block mounted on said lastnamed slideway, chart carrying means secured to said slide block andmeans for moving said slide block and chart carrying means in an arcuatepath with the said transversely extending slideway and frame maintainingsaid chart carrying means against rocking movement and from over-turningduring the movement thereof so that the horizontal axis of said chartholding means will move into successive positions which are parallelWith each other during said arcuate movement.

JULIUS F. NEUMUELLER.

